Research reveals that 90% of hip fractures are a result of falls, and most of those falls were preventable. Of the elderly fallers who require hospitalization, only 50% will survive past one year post-fall.
Our system of balance (vestibular system) is in our inner ear. It is actually part of the structure of the ear and contains three semi-circular tubes through which fluid flows each time we move. Each of these tubes is oriented in a different plane of space. The movement of the fluid over nerve endings signals to our brain where we are in space - like a small internal gyroscope. The movement of the fluid in the horizontal semi-circular canal moves in the same direction as our eyes move. (If you want to know why people throw-up on amusement park rides, send me an e-mail, snetherland@assistedca.com, and I'll send you the details!)
Balance is defined as the process by which we control our center of mass (COM) over our base of support. There are three body systems involved in balance - an intact vestibular system, vision and proprioceptive feedback. Proprioceptive feedback is the knowledge of where your body is in space without your having to look. As you're reading this, you can tell if you are sitting or standing. Good balance is dependent on at least two of these three systems working.
There are several medical factors that influence an individual's risk for falling:
Infections
Abnormal Blood Pressure
Thyroid Disorders
Diabetic Neuropathy
Decreased Vision
Depression
Cognitive Deficits
Muscle Weakness
Orthostatic Hypotension
Hearing Loss
Alcohol Usage
Number and types of medications taken:
Diuretics
Narcotic analgesics
Anti-hypertensives
Long acting sedatives
Think about advanced diabetics. The diabetes has caused visual problems (or blindness) and peripheral neuropathy (poor sensation in the hands and feet). This individual is extremely high risk for falling.
Hearing loss is usually overlooked. Remember, hearing and the system of balance are both in the inner ear. So, if there is an age related decline in hearing, there may also be an age related decline in the functioning of the vestibular system.
Cognitive deficits are also a key factor in fall risk. The automatic nature of balance diminishes in seniors. Muscle weakness, reduced active and passive dorsiflexion and the other medical issues listed are all contributing factors. Performing dual tasks puts an individual at risk for a fall. The elderly are using all their concentration to maintain their balance in a standing position. When you add a cognitive task, such as conversation, you might compromise their balance. So, if you are grocery shopping with a client or loved one and walking down the aisle of the market, in addition to the challenge of looking sideways while walking, if you ask the client or loved one a question, they are now a very high fall risk.
You can get an idea if someone has difficulty with combining ambulation and cognitive tasks when you are talking with them while out for a walk. If their walking speed is reduced when they are talking, they are a fall risk.
Sadly, older adults who fear falling will reduce their activity, fostering a sedentary lifestyle, decreasing muscle strength, ambulatory confidence, and the vicious cycle of fall risk is perpetuated.
Here are a few practical suggestions:
Remove loose throw rugs, especially those in the bathroom.
Pick up things that we typically leave on the floor, e.g., magazines, shoes, articles of clothing, boxes.
Ensure that pathways between rooms are clear and not blocked with furniture, especially in narrow hallways.
Lighting should be bright.
At night, when going to the bathroom, patients should turn on the lights, or at the very least, have a night light, lighting the way to the bathroom.
Have the client or loved one arrange for grab bars to be installed in the bathroom if necessary.
If the client or loved one is frail, they need to use an elevated toilet seat or grab bars around the toilet for more leverage when standing up.
Put skid resistant strips in the bathtub.
If an individual uses a walker or cane, how confident are they with its use? Is their equipment still appropriate for them? Is it working properly? Should their doctor arrange for a Physical Therapist to do an evaluation?
How is their standing endurance? Can they safely stand at the stove and cook a meal? Can they safely stand in the shower?
When a person with compromised balance is going to watch television and minimal distractions are critical for fall prevention, wait until they are safely seated in a chair, before you turn on the television. We don't want Oprah to say something exciting, drawing their attention while they are in the process of sitting down, causing them to fall!
Footwear is also an important consideration. Individuals at risk for falls should be wearing walking shoes or other firm soled shoe. Athletic, running type shoes, or those super-soft soled shoes are too soft and don't have a firm base of support. Discourage walking around in house slippers, especially the flip-flop type and don't wear a heel higher than 1 inch.
Hopefully, our awareness will not only help us reduce our loved one's fall risks, but keep you safe as well.
Sherry Netherland, copyright 2008
http://www.sherrynetherlandconsulting.com
http://www.ilikefitness.com
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Sherry Netherland - EzineArticles Expert Author
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